■ Proposed reforms from a bipartisan group of senators would revamp J-1 visas and other programs that improve access to physician services in underserved areas.

Washington Sweeping reforms proposed to update U.S. immigration policy would include additional visa waivers for foreign physicians who agree to practice medicine in rural areas and other regions with underserved patient populations.

Organized medicine groups praised the Senate legislation, introduced on April 16, for aiming to improve international physicians' and medical graduates' ability to immigrate to and work in the U.S. The bill — the Border Security, Economic Opportunity, and Immigration Modernization Act — would strengthen the nation's borders, provide new processes for individuals seeking to live legally in the country, and provide a potential way for some people in the country illegally to become American citizens, proponents said.

Several proposed changes in the measure to federal immigration law focus on physicians and medical graduates. However, much of the early attention to and scrutiny of the bill has been focused on sections that would provide some workers in the country illegally with a path to citizenship and that would enhance security at the borders.

“America is a nation of immigrants, but both Republicans and Democrats have failed to enforce our immigration laws, and as a result we have millions of people here illegally,” said Sen. Marco Rubio (R, Fla.), who along with seven colleagues introduced the legislation. “We are not going to deport them.”

Sen. Charles Schumer (D, N.Y.), a co-sponsor of the legislation, said the bill would be debated and amended, but he hoped it would be put to a full Senate vote before the August congressional recess.

Technical changes to federal law and a section in the legislation addressing visa waivers could improve physician immigration, said Matthew Shick, senior legislative analyst for the Assn. of American Medical Colleges. The AAMC had supported another bipartisan bill, the Conrad State 30 and Physician Access Act, which was introduced on March 19. The comprehensive immigration reform proposal largely includes the language from that act, which also has the support of the American Medical Association and the American Hospital Assn.

Conrad waivers, named after former Sen. Kent Conrad (D, N.D.), give physicians the chance to waive a two-year residence requirement once they have J-1 exchange visitor visas, according to the U.S. Citizenship and Immigration Services website. To be eligible, a J-1 physician must agree to basic requirements. He or she must: agree to be employed in a health professional shortage or medically underserved area for three years; be under contract at a health facility in that area; obtain a “no objection” letter from his or her home country; and begin work within 90 days of receipt of the waiver.

The American Medical Association supports the permanent reauthorization of the J-1 visa waiver program that allows international medical graduates to continue providing much-needed health care to people in communities around the country, said AMA President Jeremy A. Lazarus, MD.

“IMGs play an integral part in American medicine, often joining physicians in practices serving patients in rural and low-income urban areas,” Dr. Lazarus said. “We also support provisions that exempt physicians from green card caps upon completion of their service requirement, require more transparency in employment contract terms, create more waivers per state for academic medical centers and establish a mechanism to increase the number of visa waivers per state.”

Visa waivers hard to come by

Each state receives up to 30 waivers per year, and they often are snapped up quickly. For instance, the Virginia Dept. of Health has no slots available, according to its website. The Pennsylvania Dept. of Health reports that it received 39 applications and has just eight vacant slots remaining.

The immigration bill would create three new Conrad slots per state for academic medical centers and employ a formula to increase state waivers by five whenever 90% of them are filled nationwide.

“Conrad 30 is the most popular, as you're allowed to stay in the country, and it puts you on a pathway for a green card and eventually citizenship,” Shick said.

Rural physicians, hospitals and other stakeholders were pleased to see that the threshold for waivers would increase under the Senate proposal, said Maggie Elehwany, vice president of government affairs and policy for the National Rural Health Assn. Lawmakers might want to consider adding a provision allowing for unused waiver spots to be shifted to states that have reached their capacities, she said. Physician shortages are found in rural areas around the country, and the Conrad program is only one vehicle to improve access to health services.

Other sections of the immigration bill would increase the allocation of visas for professionals with advanced education, which includes those with medical degrees, to 40% from 28.6%. Eligible medical residents and physicians also would be exempt from worldwide immigration caps.